Emergency Submission to Supplement OMB Control Number 0920-0900 in Context of Contact Investigations Associated with Ebola and Travel

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Ebola Exposure Questionnaire for Passengers on Other Commercial Conveyances	Form	New	Available
Ebola Exposure Questionnaire for Airport Staff	Form	New	Available
Ebola Exposure Questionnaire for Cleaning Crew	Form	New	Available
Ebola Exposure Questionnaire for Flight Crew	Form	New	Available
Ebola Exposure Questionnaire for Airline Passengers	Form	New	Available
Airport or Other Port of Entry Staff Assessment	Form	Removed	Available
Cleaning Crew Assessment	Form	Removed	Available
Crew Assessment	Form	Removed	Available
Passenger Assessment	Form	Removed	Available
Introduction and confirmation	Form	Unchanged	Available
Attachment G Risk stratification.docx	Supplementary Document	Uploaded 2014-11-18	Available
OMB package non-substantive change to Ebola Exposure for Airline Contact Investigation questionnaire.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2014-11-18	Available
Emergency Request Contact Investigations Part A.doc	Supporting Statement A	Uploaded 2014-10-16	Available
USCODE-2009-title42-chap6A-subchapII-partG.pdf	Supplementary Document	Uploaded 2014-10-16	Available
Emergency Request Contact Investigations Part B.docx	Supporting Statement B	Uploaded 2014-10-16	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
213971	Ebola Questionnaire for Passengers on Other Commercial Conveyances	Form	New	Ebola Exposure Questionnaire for Passengers on Other Commercial Conveyances
213970	Ebola Exposure Questionnaire for Airport Staff	Form	New	Ebola Exposure Questionnaire for Airport Staff
213969	Ebola Exposure Questionnaire for Cleaning Crew	Form	New	Ebola Exposure Questionnaire for Cleaning Crew
213968	Ebola Exposure Questionnaire for Flight Crew	Form	New	Ebola Exposure Questionnaire for Flight Crew
213967	Ebola Exposure Questionnaire for Airline Passengers	Form	New	Ebola Exposure Questionnaire for Airline Passengers
213516	Airport or Other Port of Entry Staff Assessment	Form	Removed	Airport or Other Port of Entry Staff Assessment
213515	Cleaning Crew Assessment	Form	Removed	Cleaning Crew Assessment
213514	Flight Crew Assessment	Form	Removed	Crew Assessment
213513	Passenger Exposure Assessment	Form	Removed	Passenger Assessment
213512	Script Introduction and Confirmation	Form	Unchanged	Introduction and confirmation

ICR Details

OMB Control No: 0920-1032	ICR Reference No: 201411-0920-006
Status: Historical Active	Previous ICR Reference No: 201410-0920-022
Agency/Subagency: HHS/CDC	Agency Tracking No: 15BW
Title: Emergency Submission to Supplement OMB Control Number 0920-0900 in Context of Contact Investigations Associated with Ebola and Travel
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Emergency	Approval Requested By: 10/16/2014
OIRA Conclusion Action: Approved without change	Conclusion Date: 11/19/2014
Retrieve Notice of Action (NOA)	Date Received in OIRA: 11/18/2014
Terms of Clearance: Previous TOC apply.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2015		04/30/2015
Responses	34,800	0	33,000
Time Burden (Hours)	5,349	0	4,749
Cost Burden (Dollars)	0	0	0

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Abstract: The Centers for Disease Control and Prevention is requesting emergency clearance to perform contact investigations of individuals who may have come into contact with travelers that are confirmed to have Ebola infection.

Emergency Justfication: Additional information is needed to better assess the risk to individuals who may have been exposed to a confirmed case of Ebola in the U.S.

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Authorizing Statute(s): US Code: 42 USC 70-71 Name of Law: Public Health Service Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 6

table that charts list of burden

IC Title	Form No.	Form Name
Airport or Other Port of Entry Staff Assessment	none	Airport or Other Port of Entry Staff Assessment
Cleaning Crew Assessment	none	Cleaning Crew Assessment
Ebola Exposure Questionnaire for Airline Passengers	None	Ebola Exposure Questionnaire for Airline Passengers
Ebola Exposure Questionnaire for Airport Staff	None	Ebola Exposure Questionnaire for Airport Staff
Ebola Exposure Questionnaire for Cleaning Crew	None	Ebola Exposure Questionnaire for Cleaning Crew
Ebola Exposure Questionnaire for Flight Crew	None	Ebola Exposure Questionnaire for Flight Crew
Ebola Questionnaire for Passengers on Other Commercial Conveyances	None	Ebola Exposure Questionnaire for Passengers on Other Commercial Conveyances
Flight Crew Assessment	none	Crew Assessment
Passenger Exposure Assessment	none	Passenger Assessment
Script Introduction and Confirmation	none	Introduction and confirmation

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	34,800	33,000	0	1,800	0	0
Annual Time Burden (Hours)	5,349	4,749	0	600	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: Changes due to Non-Substantive Emergency Change Request

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Annual Cost to Federal Government:

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 11/18/2014

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